The Depression Cure: book review

Every other week I help run a book club for people suffering from depression (the emails from the Depression Alliance are headed up “DABOOKCLUB” which makes it all sound quite street). It’s a small group of people, strangers really, meeting up in a cafe to talk about the book and how things are going. Often when I mention I’m going, people look a bit horrified (“er, that sounds…depressing”). But, actually, I always leave feeling heartened. The people who go may be unable to love themselves, may be lost, tired, but without exception they are touchingly compassionate towards each other. Someone will venture to discuss why things are not so good at the moment – medication not making a difference, therapy a six week wait away, friends uncomprehending – and all eyes will be on them, intent, heads nodding encouragement. It’s sort of lovely.

Anyway, I thought I would write about the books that we’re reading. It takes a couple of months to get through each one (we tend to do a couple of chapters every fortnight) so I’ll write when we get to the end.

Dr Ilardi is associate professor of clinical psychology at the University of Kansas. I like his tone. He’s energetic, encouraging and optimistic. “Depression is beatable,” he writes in his introduction. The programme is “the most promising treatment for depression I’ve ever witnessed in my years of clinical research and practice”. There’s a combative note, too: “I will never underestimate this treacherous foe. . . I’ve devoted my career to fighting this disorder” which I think some people, at least, will enjoy. It reminded me of a conversation I had with the head of a mental health charity who described how she had “thrown everything I could” at depression.

Nevertheless, some in our group found Dr Ilardi’s optimism grating. If you’ve been fighting this particular foe for years, or even decades, and keep finding yourself pinned down, it’s hard to trust somebody who promises that This is the thing that will finally enable you to triumph.

The programme – Therapeutic Lifestyle Change (TLC) – comprises six lifestyle changes. With the exception of one, I think they will be familiar to most people who have suffered from depression: physical exercise, omega-3 fatty acids, natural sunlight exposure, restorative sleeps, social connectedness and meaningful, engaging activity. Do all six of these, Dr Ilardi says, and you will get better. He cites a large treatment study at his university whereby patients were randomly assigned either to TLC or treatment-as-usual in the community (mostly medication). While fewer than 25% of those in the second group got better, the response rate for the former was three times higher. “In fact, every single patient who put the full programme into practice got better, even though most had already failed to get on well with antidepressant medication”. Getting better is defined as at least a 50% reduction in depressive symptoms and no longer meeting diagnostic criteria for major depressive disorder.

Having got to the end of the book, I would say that the key phrase here is “who put the full programme into practice”. There is no clarification here about the proportion of patients who fail to do this. This seems an important omission given that the changes require a degree of willpower that might be difficult for a depressed person to exercise. In the final chapter (“When roadblocks emerge”), Dr Ilardi acknowledges this, observing that his programme “might look like some sort of cruel pipe dream – something that sounds great on paper but that proves impossible to put into practice in the real world.” The answer he gives is simple enough – get a “coach” to help you to persevere – but it does boil down to an act of the will.

As the author acknowledges, the changes recommended already have an evidence base behind them, and none are likely to cause any harm. What Dr Ilardi has done is to package them together with some specific metrics – a precise dose of Omega 3 (be warned, it’s not cheap), a specified amount of sunlight etc

He also spins a fairly compelling narrative about why depression is so common today, which, he suggests, explains why the programme is so effective. In short, he believes that “human beings were never designed for the poorly nourished, sedentary, indoor, sleep-deprived, socially isolate, frenzied pace of twenty-first century life.” He’s quite convincing on this topic. People in our group had their own theories about why they had experienced depression, often centred on specific circumstances, but weren’t opposed to this narrative, perhaps because it helpfully challenges the the tendency of those with depression to blame themselves for their condition.

The treatment of depression is something of a battleground for practitioners, a state of affairs that can be quite confusing for patients. It’s fair to say that Dr Ilardi is not a great fan of anti-depressant medication, citing “low rates of recovery, high rates of relapse, and an astonishing array of serious side effects”. He is fairly dismissive of traditional psychotherapy but a proponent of CBT. However, this isn’t a political book – there’s no axe-grinding really, although he is fairly evangelical about the programme, peppering each chapter with case studies of patients who’ve reported dramatic improvements.

Personally, I think the best chapters are those on rumination – apparently we are unlikely to have any fresh insights about a problem after ten minutes of mulling it over – and “getting connected”. This last was the chapter that seemed to explore the questions most troubling the group: who should I reach out to? Is it bad to hang out with other people with depression? What should I talk about, my depression or other topics? There’s some great practical advice here, no-nonsense but kind.

I’d recommend this book to people who like precision. If you like being prescribed specific actions, ticking things off a list, measuring your progress, then this book is for you. It requires a certain amount of dedication but I don’t doubt that it’s been very effective for those that have stuck with it. It reminded me a lot of healthy eating books that (rightly) dismiss fad diets and wonder cures and preach the tough but kind message that what’s really required is a lifelong change of habit. Dr Ilardi expects quite a lot from people, I think, but he’s an accomplished cheerleader.

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